nihr clahrc east midlands annual meeting 2015 presentations - day 1

WelcomeNIHR CLAHRC East Midlands Annual Meeting

Growing Momentum – Sharing and Learning

A partnership between

Nottinghamshire Healthcare NHS Foundation Trust

and the Universities of Nottingham and Leicester

24 March 2015, Eastwood Hall Hotel, Nottingham

East Midlands

Prevalance of Long Term Conditions • 15 million with LTC

• 70% NHS Budget

NHS Outcomes Framework 5 Domains

Public Health England Priorities

Department of Health Priorities for the East Midlands (Set out in the East Midlands Health Strategy 2009)

“The priorities for the East Midlands are to address health inequalities, levels of tobacco use, harmful alcohol use, obesity, physical activity, avoidable injury and death, affordable warmth and the health of children and young people.”

Key National and Local Priorities

Contributions from Matched Funding

NIHR CLAHRC East Midlands

Structure

• Improve patient outcomes

• Bring together health stakeholders to support the NHS to meet locally identified priorities

• Bridge the second gap in translation

• Implement partnership model for (a) research in public (b) uptake of research evidence into practice

• Increase capacity in the East Midlands

• Understanding conditions for the uptake of research

CLAHRC EM Objectives

“Improve patient outcomes through the conduct and

application of research evidence of local relevance and international quality”

Applied Health Research

Year One

• 18 Phase One and Two projects are up and running across the East Midlands.

• 10 Projects provisionally selected for Phase Three from an rigorous approach involving Partners and Public

Bringing People Together

Year One

• Received £591k cash matched funding

• On track to receive £18m overall

• Set up the East Midlands CLAHRC faculty. We currently have 90 members.

• PARADES Event in December 2014 with the EM AHSN #StephenFryLiked

• Developed an Industry Strategy which has been distributed by the NIHR to all other CLAHRCs

“Build on the achievements of the LNR and NDL CLAHRCs in

bringing together stake holders to support the NHS to meet locally identified priorities”

“Bring about a further step change in the quality and

quantity of activity taking place to bridge the second gap in

translation”

Implementing Evidence

Year One

• EM AHSN have pledged funding of £525,000 to support the implementation of CLAHRC EM projects.

• Appointed 34 knowledge

brokers who are playing a key

role in developing research

interest and capability

“Implement and evaluate a partnership model for (a) co-producing research in public

health and chronic disease, and (b) co-producing the rapid

uptake of research evidence into widespread practice”

Our Partnership Model

Year One

• Knowledge Translation strategy has been developed and disseminated amongst project teams and successful Phase 3 applicants

• All research theme staff have attended implementation workshops

“Increase capacity in the EM to conduct high quality health

research and to apply research evidence”

Capacity Development

Year One

• We have appointed seven PhD students and three more planned in September

• Commenced our training programme presenting short courses for NHS staff in 2015. Courses were put forward after consultation with NHS partners.

“Develop a greater understanding of the necessary and desirable conditions for the uptake of research findings and

spread of evidence-based practices”


Year One

• Researchers in the IEI Theme have commenced 3 studies which covers PPI, use of technology in implementation and analysis in the CLAHRC

• All research teams complete Quarterly Reports creating a log of implementation activities and approaches. This will provide a valuable resource.

Year One

• PPI strategy completed and being implemented.

• Partners Council set up and meeting regularly.

• Set up the Centre for BME Health. The Centre has already delivered 11 community health information events to raise awareness of diabetes and safer fasting during Ramadan to more than 250 individuals from 13 different ethnic groups.

Public Involvement

“Provide opportunities for stakeholder engagement and across

all of its structures, themes and projects so that intended end-users

of research can help to shape its selection, design, delivery,

dissemination and implementation”

• Overview of our progress including

achievements

• Give a wider perspective on the

relationship between our partners

• Outline our challenges

• Encourage networking

• To thank you for all that you have done

in the last year.

• We could not have achieved this

without your support!

Aims and Objectives of Today

Mission Statement

Thank you for listening and

Enjoy the Day

[email protected]

www.clahrc-em.nihr.ac.uk

@kamleshkhunti

@CLAHRC_EM

This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this presentation are those of

the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

NIHR CLAHRC East Midlands - Embedding a

Mature CLAHRC

Chair – Professor Kamlesh Khunti, Director




‘Building Partnerships’

Karen Glover

Director of Partner Relations and Operations,

NIHR CLAHRC EM

Head of Clinical Programmes EM AHSN


Nottinghamshire Healthcare and the

Universities of Nottingham and Leicester

• NHS, Industry, Academia

• Voluntary Sector and Local Authorities

• Patients/Public

• Region-wide: BRU, CRN, SCN, Clinical Senate,

HEEM, EMLA, AHSN

• National NIHR CLAHRC

Who are our Partners?

• Improve Population Health

• Increase Capacity and Capability for Research

and Innovation

• Shared Understanding and Ownership

• Translation of Research into Practice

Why Collaborate?

• Communications

• Networks

• Events

• Organisational Presentations - NHS, Academia

• Industry

How Do We Engage?

• Governance Arrangements

• Project Selection

• CLAHRC Faculty

• Networks of Practice

• Knowledge Brokers

How Do We Engage?

Thank you for listening

[email protected]


@CLAHRC_EM



NIHR CLAHRC East Midlands Annual Meeting





Co-Production & Translation

Justin Waring,

IEI Theme Lead, CLAHRC East Midlands




Getting evidence into practice

The Translation Gap!

Research evidence takes a long time

make an impact on clinical practice

and service delivery

The problem

Closing the Gap

Implementation research offers a

range of ideas and techniques to help

get knowledge into practice

Understanding the gap

• Clinical Research and Clinical Practice operated in different ways:– Separated by a common language

– Characterised by different cultures

– Measured and assessed in terms of different performance

– Driven by different pressures and priorities

• Clinical research is often done ‘on’ clinical practice, not ‘with’ clinical practice

– Research questions reflect the interests of researchers, not needs of practitioners

– Research design does not take into account local operational issues

– Research activities can treat practitioners as ‘subjects’

– Research findings are not valued or recognised by practitioners

– Research does not make a meaningful or lasting impact on practice

Mode 1 or Mode 2 Research

CLAHRCs are designed to close this gap between research and practice

through acting as the collaborative bridge...Mode 2 Research

NIHR CLAHRC-EM undertakes world-class applied health research that aims to close the gap between research and practice!

• Applied research – research that tests ‘proven interventions’ in the context of local care services and needs

• Closing the gap – research that is ‘co-produced’ by research and practice communities so that it fits with the context of local care services and needs

• Co-production – where research teams and practitioners work together to design and ‘implement’ applied research

• Implementation research – research that aims to understand how best to co-produce and implement research

The CLAHRC Approach

We have learnt a lot about what works in closing the gap…

• Communication & Translation

• Engagement

• Teamwork

• Dealing with ‘push-back’

• Timing & Pace

The benefits of a mature CLAHRC

Mapping out the journey

Getting Research Into Practice (GRIP)

• Develop and conduct applied research that is relevant to our NHS partners, and to

translate the research findings into improvement outcomes for patients

• Create a distributed model of implementation and translation that links those who

conduct applied research with those who will use it

• Create and embed approaches to applied research that takes into account the way

care is organised and delivered across our region and aligns with AHSN

• Increase capacity for applied health research and translation

Our approach

• NHS partners should be involved in the initial stages of problem definition and project specification and all stages of research activity – after all our partners will use the findings

• Project teams (of researchers and practitioners) need to build implementation and translation into their research activities – it cannot be ‘done’ by someone else or after the research findings have been collected (this would recreate the gap)

• By understanding the wider environment research can make a sustained impact and ideally be spread at scale and pace with relevant partners

• By building capacity within both clinical and practice communities, we can ensure the long term and sustained generation and use of evidence and its translation into practice

What does this mean?

Knowledge brokers help ‘get the right information, to the right people, at the right time’

• They are intermediaries or go-betweens who work between research and practice

partners

• They identify insight or information that might be of use to other partners

• They translate insight and information so it is in an appropriate format and language

• They communicate insight between partners

• The can champion change and support the use of insight between communities

Knowledge Brokers

Co-production and translation is based upon the formation of new teams, communities or

networks between research and practice partnership

• Networks help bring together diverse partners around a shared purpose

• Networks coordinate activities and foster cooperation

• Networks help build a critical mass of energy, expertise and experience

• Networks support knowledge sharing and learning

• Networks can become self-sustaining

Networks

1. CLAHRC projects are based on co-production and partnership between research

(knowledge producers) and practice communities (problem owners)

2. Project teams are responsible for developing their own co-production and translation

activities to reflect their specific challenges, but with the support of the CLAHRC team

3. Project teams should look to use knowledge brokers and/or networks as a way of co-

producing and translating research into sustained service improvement

Key points


[email protected]


@CLAHRC_EM



CLAHRC EM Annual Meeting 24th

March 2015

Growing momentum:

Sharing & Learning

Working with the EM AHSN

Professor Rachel Munton

Managing Director, EMAHSN

EM CLAHRC/AHSN have clear and complementary aims and related clinical foci

Both shaped to ensure the two organisations work together effectively to deliver signification improvements

Agreed approach that differentiates between the academic discipline of implementation/improvement science and the change activity of evidence-informed practice improvement

East Midland’s approach

“There is a clear relationship between the

EM CLAHRC and EM AHSN, with the

CLAHRC resources supporting the

generation of high quality and locally

relevant evidence and developing the

science of implementation and the AHSN

supporting the practicalities of “putting

evidence into practice” at a suitable

stage of development.”

INVENTION EVALUATION ADOPTION DIFFUSION

NIHR

Infrastructure

BRCs , BRUs etc

NIHR

Infrastructure

CLAHRCs

AHSCs AHSNs

NHS

Patient Care

NHS

Patient Care

NIHR

Infrastructure

Clinical Research Network

NIHR

Programmes

MRC

Programmes “improving patient outcomes through the conduct and

application of applied healthresearch”

Research and Innovation Landscape


NIHR

Infrastructure

BRCs , BRUs etc

NIHR

Infrastructure

CLAHRCs

AHSCs AHSNs

NHS

Patient Care

NHS

Patient Care

NIHR

Infrastructure


NIHR

Programmes

MRC

Programmes“AHSNs have a complementary role in the translation process by focusing on the adoption and spread of innovative clinical practice that are of proven cost-effectiveness, across whole

healthcare systems, linking back with the research and development community.”



NIHR

Infrastructure

BRCs, BRUs, CRFs

NIHR

Infrastructure

CLAHRCs

AHSCs AHSNs

NHS

Patient Care

NHS

Patient Care

NIHR

Infrastructure


NIHR

Programmes

MRC

Programmes


Specific research related activity

–from NHS England AHSN

licence measurements

Measurement 5: summary of research

evidence that has successfully been

implemented and translated into practice, and

provide evidence of working with NIHR

CLAHRCS

Measurement 12:work with their Clinical

Research Networks and demonstrate how they

have supported delivery of their metrics

Specific research related activity –

from NHS England AHSN licence

measurements

Measurement 13: demonstrate how the AHSN has supported the delivery of NIHRS objectives. AHSNs may seek to engage in additional research activities beyond those agreed within NIHR objectives –in this case the AHSN must demonstrate how the research aligns with the AHSNs clinical or service priorities, expenditure, clinical and ROI activities

Measurement 14: reflect the breadth and depth of the AHSNs academic partnerships ensuring that academic collaboration is not fixed around a single institution

Contact details

Rachel Munton, Managing Director

[email protected]

0115 82 31300 I 07825 656341

Overview of the NIHR Infrastructure:

providing the facilities and people for a thriving

research environment

Dr Tony Soteriou, Acting Deputy Director

Head of NHS Research Infrastructure and Growth

Research and Development Directorate

CLAHRC East Midlands

24 March 2015

• improve health outcomes through

advances in research

• improve quality of care by NHS

participation in the research process

• strengthen International competitive

position in science

• drive economic growth through

investment by life science industries

Why is the Government committed to Research in the NHS?

Patients

NHS

Universities

Health Research Challenges, 2005

NHS R&D funding

was allocated on

a historical basis

NHS Trust

management

was seen as the

bureaucratic

block to clinical

research

Few effective

incentives for

research in the

NHS

Dramatic fall in

numbers of

clinical

academics

40% of clinical

academics

funded by NHS

Difficulty in

developing

sustainable

capacity

Problems with

career paths for

all professions in

research

Low “applied”

evidence base

Perception that

NHS research

funding was

second class

Perception that

applied health

research was

second class

Vision

“To improve the health and wealth of the nation through research.”

January 2006

Infrastructure

Clinical Research

Facilities, Centres

& Units

Clinical Research

Networks

Research

Research Projects

& Programmes

Research

Management

Systems

Research

Information

Systems

Systems

Patients

&

Public

Universities

Investigators &

Senior

Investigators

Associates

Faculty

Trainees

Research Schools

NHS Trusts

NIHR Health Research System

National Institute for Health Research

• Between Government, Charity and Industry

• Between NHS and University

• Between research leaders and research facilitators

• Between different health care professions

• Between different research disciplines

• Between researchers and patients

An Integrated Health Research System

Partnership

Biomedical Research Centres

Basic Research

National Institutefor Health Research

This pathway covers the full range of

interventions - pharmaceuticals,

biologicals, biotechnologies, procedures,

therapies and practices - for the full range

of health and health care delivery -

prevention, detection, diagnosis,

prognosis, treatment, care.

Patient Safety Translational Research Centres

Research for Patient Benefit

Programme Grants for Applied Research

Health Technology Assessment

Invention for Innovation

Collaborations for Leadership in Applied Health Research and Care

Centre for Reviews & Dissemination, Cochrane, TARs

Development Pathway Funding

Public Health Research

Health Services and Delivery Research


NHS England Commissioning

National Institute for Health & Care Excellence Guidance on Health & Healthcare

NHS Supply Chain Support for Procurement

NHS Evidence Access to Evidence

InnovationAcademic Health Science Networks

Patient CareProviders of NHS Services

Clinical Research Facilities

Experimental Cancer Medicine Centres

Horizon Scanning Centre

Centre for Surgical Reconstruction & Microbiology

Biomedical Research Units

MedicalResearch Council

The central role of NIHR research in the innovation pathway

Healthcare Technology

Co-operatives

Research Schools

Efficacy Mechanism and Evaluation

Diagnostic Evidence

Co-operatives

Infrastructure

Clinical Research Networks

Clinical Research Facilities, Centres &

Units

Aim

Harness the research potential of the NHS to improve health and deliver competitive advantage for increased economic growth

“… the support and facilities the NHS needs for first class research…”

Infrastructure


Clinical Research Facilities, Centres &

Units

• Clinical Research Networks

• Biomedical Research Centres

• Biomedical Research Units

• Translational Research Partnerships

• Translational Research Collaborations in

Rare Diseases and Dementia

• Clinical Research Facilities

• Experimental Cancer Medicine Centres

• Patient Safety Translational Research

Centres

• Collaborations for Leadership in Applied

Health Research and Care

• Healthcare Technology Cooperatives

• Diagnostic Evidence Cooperatives

NIHR Clinical Research Infrastructure

Biomedical Research Centres

Biomedical Research Units

Clinical Research Facilities

Experimental Cancer Medicine Centres


Invention Evaluation Adoption

Healthcare Technology

Co-operatives

Diagnostic Evidence

Co-operatives

Patient Safety Translational

Research Centres

Collaborations for Leadership in

Applied Health Research and Care

Translational Research

Partnerships and

Collaborations

NIHR Biomedical Research CentresNewcastleOxfordCambridgeSouthamptonImperialUCLHGreat Ormond StMoorfieldsGuy’s and St ThomasRoyal MarsdenSouth London and Maudsley

NIHR Healthcare Technology Co-operativesBirminghamBradfordLeedsNottinghamSheffieldBartsCambridgeGuy’s & St Thomas’

NIHR Biomedical Research UnitsNewcastle – dementiaLeeds – musculoskeletalCentral Manchester – musculoskeletalLiverpool – gastrointestinalNottingham – hearing/respiratory/gastrointestinalLeicester – cardiovascular/respiratory/nutritionBirmingham – gastrointestinalBristol – cardiovascular/nutritionOxford – musculoskeletalSouthampton – respiratoryLondon Imperial – cardiovascular/respiratoryBarts – cardiovascular UCL – dementiaSouth London and Maudsley - dementia

NIHR-supported Clinical Research FacilitiesAlder HeyBirminghamBrighton and SussexCambridgeThe ChristieExeterGuy’s and St ThomasImperialLeedsManchesterMaudsleyMoorfieldsNewcastleOxford cognitive health SheffieldSouthamptonSouth Manchester respiratory and allergyRoyal MarsdenUCLH

NIHR-Supported Facilities

Newcastle

Leeds

Sheffield

Leicester

Oxford

Bristol

Brighton

Peninsula

London

Bradford

NIHR Diagnostic Evidence Co-operativesImperialLeeds NewcastleOxford

Manchester

NIHR/CR-UK Experimental Cancer

Medicine CentresBirminghamCambridgeLeedsLeicesterBarts/ BrightonICRImperialKing’s College LondonUCLManchesterNewcastleOxfordSheffieldSouthampton

Liverpool

Exeter

Southampton

NIHR Collaborations for Leadership inApplied Health Research and Care

East of EnglandEast Midlands

Greater ManchesterNorth Thames

North West CoastNorth West London

OxfordSouth London

South West PeninsulaWest

West MidlandsWessex

Yorkshire and Humber

Cambridge

Nottingham

Birmingham

NIHR Collaborations for Leadership in Applied Health Research and Care

• 9 Pilot CLAHRCs created in 2008 for 5 years

• £50m funding awarded (rising to £88m over course of award)

• Second competition: 13 CLAHRCs funded for 5 years from January 2014

• Funding increased to £124 million

• Address the “second translational gap”

Aims of the CLAHRCs

• to develop and conduct applied health research relevant across the NHS, and to translate research findings into improved outcomes for patients;

• to create a distributed model for the conduct and application of applied health research that links those who conduct applied health research with all those who use it in practice across the health community;

• to create and embed approaches to research and its dissemination that are specifically designed to take account of the way that health care is delivered across the local AHSN;

• to increase the country’s capacity to conduct high quality applied health research focused on the needs of patients, and particularly research targeted at chronic disease and public health interventions;

• to improve patient outcomes locally and across the wider NHS; and

• to contribute to the country’s growth by working with the life sciences industry.

North West London

Greater

Manchester

West Midlands

South WestPeninsula

Yorkshire & Humber

13 NEW Collaborations from January 2014

East of England

NIHR Centres for Leadership in Applied Health Research and Care (CLAHRCs)

East Midlands

South London

North West Coast

North Thames

Oxford

West Country

Wessex

Pilot scheme to 2014

http://upload.wikimedia.org/wikipedia/en/e/e4/CPRE_England_tranquillity_map.jpg

http://upload.wikimedia.org/wikipedia/en/e/e4/CPRE_England_tranquillity_map.jpg

CLAHRC Themes, 2014

Overall NIHR CLAHRC programme outputs: 2008 - 2013

Research projects

Implementation Projects

Publications

1,012

575

1,485

Subjects recruited

3,194,423

External income Generated

£74,707,024

Higher degrees

1,494

£0

£2

£4

£6

£8

£10

£12

£14

£16

2009/10 2010/11 2011/12 2012/13 2013/14

Mill

ion

s

DH/NIHR

Research council

Research Charity

Other non-commerical

Industry Funding

Pilot CLAHRC types of external funding

Pilot CLAHRC types of external funding(5-year Total )

CLAHRC Impacts – East Midlands

• IMPAKT (IMProving Patient Care and Awareness of Kidney disease progression Together) software tool can identify Practice patients at risk from CKD:

- being implemented across the country in a number of CCGs and AHSNs including the whole of Wales.

- adopted by Manchester’s AHSN and the East Midlands Strategic Clinical Network.

- used by HQIP to describe QI requirements for the national CKD audit.

The tool continues to identify patients at risk from CKD enabling early intervention and potentially saving the NHS £millions.


• Diabetes education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) programme:

- Offered by more than 60% of providers within the UK

- Significant increase in the number of people with type 2 diabetes using DESMOND as a consequence of the programme acquiring QOF points in March 2013.

- Utilised in a number of international settings


• Walking Away from Diabetes - a structured education programme encouraging and supporting physical activity in those at risk from diabetes:

- recommended for use in the NICE Guidelines for Early Intervention and Prevention of Diabetes.

- commissioned by 9 CCGs in England as well being used in health services in Ireland, Gibraltar and Western Australia.

CLAHRC Impacts - East Midlands

• The Individual Placement and Support (IPS) which aims to help people with mental health problems achieve paid employment:

- Study led to 34% of participants finding employment within a year of undertaking the programme.

- A further 26% went into education, training or voluntary work.

- When comparing the results with the Department of Work and Pension’s own Work Programme using the DWP’s own outcome measure, IPS programme was 9% more effective.

CLAHRC Impacts - East Midlands

• Return to Work After Strokestudy aims to address the problems of getting stroke survivors back to work and to design a vocational rehabilitation (VR) service for people who have had a stroke:

- Stroke survivors were twice as likely to be in work compared to usual care at 12 months after stroke

- Intervention found to be cost effective, saving £3,000 per case (total of health and social costs).

CLAHRC - Impacts


3,100 trainees were supported in the NIHR infrastructure between April 2013 and March 2014.


NIHR

Infrastructure

BRCs, BRUs, CRFs

NIHR

Infrastructure

CLAHRCs

AHSCs AHSNs

NHS

Patient Care

NHS

Patient Care

NIHR

Infrastructure


NIHR

Programmes

MRC

Programmes

NIHR and the Research and Innovation

Landscape

CLAHRC East Midlands:Contribution to Growth

Case Example: Supporting efficient use of NHS resources

The NIHR’s Key Contributions to Growth

• Supporting collaborations and contract research with the life sciences industry

• Creating the research environment that supports the nation’s international competitiveness

• Attracting, developing and retaining a highly skilled health research workforce

• Providing the clinical evidence to help the NHS and public sector to make efficient use of resources

• Providing the research evidence that contributes to establishing a healthier workforce and wider population

Major focus on Life Sciences

• Establish Health Research Authority

• NIHR funding conditional on 70 day

benchmark for trial start-up

• More information about clinical trials to

enable greater public involvement

• Build consensus on using e-health

record data

• Establish Translational Research

Partnerships

• Encourage innovation in NHS

procurement

• NHS Chief Executive to report on

accelerating adoption and diffusion of

innovation in the NHS

Research and the NHS:

Plan for Growth

BIS & DH Prime Minister

Strategy for UK Life Sciences

“Life science - and the UK’s role

in it - is at a crossroads.

Behind us lies a great history of

discovery, from the unravelling

of DNA to MRI scanning and

genetic sequencing.

We can be proud of our past,

but this government is acutely

aware that we cannot be

complacent about the future.”

David Cameron

December 2011

Research and Growth:

Strategy for UK Life Sciences

Summary

• NIHR is a health research system in the NHS

• Health and Wealth of the nation through health research

• NIHR CLAHRCs an important part of NIHR Research Infrastructure – focussed on closing the gap between evidence and practice

• CLAHRC impacts have led to increased funding

• New NIHR CLAHRC East Midlands

• CLAHRCs contribute to NIHR’s mission to improve the health and wealth of the nation through research.

The NIHR in numbers

Overview of the NIHR Infrastructure:

providing the facilities and people for a thriving

research environment

Dr Tony Soteriou, Acting Deputy Director

Head of NHS Research Infrastructure and Growth

Research and Development Directorate

CLAHRC East Midlands

24 March 2015

Join the conversation

If you hear something you like, or want to

challenge, or simply want to share an

observation, join the Twitter conversation using

@CLAHRC_EM and #clahrc in your tweet.

#clahrc@CLAHRC_EM

NIHR CLAHRC East Midlands related Twitter accounts

@EMRAN_ageingEast Midlands Research into Ageing Network

@EMCBMEHEast Midlands Centre for Black and Minority Ethnic Health

Connecting to venue WiFi

• Load web browser

• Click “conference” on homepage

• Enter Username diabetes1, Password diabetes1

Username:

diabetes1

Password:

diabetes1

What Success Looks Like: Reflecting from

CLAHRC

Chair – Beth Allen, Infrastructure Manager, Department of

Health




CLAHRC EM Scientific Committee

Richard MorrissDirector of Research CLAHRC EM




• To ensure that all CLAHRC funded research projects above £50,000 are of high scientific quality compatible with world class applied healthcare research

• Fit with the overall principles of CLAHRC EM –

– Active PPI involvement

– Implementation plan in East Midlands

– value for money

• Assurance of money well spent to partners, including NIHR, through CLAHRC Board

Purpose

1. External peer review (3 subject reviewers), PPI review, AHSN review, methods review (statistics, health services research, qualitative/organisation science) 1 month before Scientific Committee

2. Scientific Committee, externally chaired, and all voting members independent but familiar with CLAHRC:

primary care chairstatisticianhealth services researchPPIsociologist

Stages

1. Scientific Committee meets when required according to anticipated submission of projects (chief investigator, CLAHRC and theme managers)

2. Considers all reviews, discusses, makes recommendations to CLAHRC EM Director and CLAHRC EM Board

3. 4 decisions:

Pass - no further recommendations, consider reviewer’s comments

Minor amendment - project can start, expect reply, SC and reviewer comments optional to address

Major amendment - project cannot start until SC and reviewer comments are addressed

Reject and resubmit

Process

1. Chief investigator and theme manager

2. Summary reported as standing item to CLAHRC EM Executive and CLAHRC EM Board

Reporting

1. Quarterly reports from each project to Director of Performance

2. Annual review of all projects based on reports to Director of Performance as chosen by Chair of Scientific Committee

3. Formative suggestions to improve performance of underperforming or delayed projects

4. Summative recommendations to CLAHRC EM Director and CLAHRC EM Board if project is failing to deliver

Ongoing Monitoring of Projects

19 projects have been reviewed:

1 passed

4 minor amendment

10 major amendment - 9 then passed,

- 1 redesigned & passed.

4 rejected - 3 redesigned & passed

1 to be redesigned

Results

Weakness:

Delay in starting project

Benefits:

Increased PPI, implementation, better quality design, meets ethics peer and statistics review, value for money,

assurance for partners with receipt of matched funding

Benefits and Weaknesses

Individual Placement & Support

Eric Wodke

IPS Development Manager

The Positive Impact of Individual Placement and Support (IPS) on People with Severe Mental Health Problems in Nottingham: An

Implementation ApproachAIMS

1. Implement IPS into secondary mental health service in Nottingham

2. Support service users into work and related vocational activities

3. Compare IPS alone with IPS work focused psychological support

Results

• 74 people recruited into study

• 59% of sample attained paid work and related opportunities

• Colocation of employment specialist into clinical teams – key to implementation

• Establish Steering group to drive change management process – key to implementation

Evidence base• Vocational rehabilitation for people with severe mental illness, Cochrane

database of systematic reviews (Marshall et al 2001):

• An update on randomised controlled trials of evidence based supported employment – IPS. Psychiatric Rehabilitation Journal 31, 280-290 (Bond et al 2008):

• The IPS approach to vocational rehabilitation for young people with first episode psychosis in the UK. Journal of Mental Health 19(6): 483-491 naturalistic evaluation

• First episode psychosis and employment. International Review Of Psychiatry Literature review, April 2010:22(2): 148-162 (Rinaldi et al 2010)

Evidence base• Client characteristics little impact on vocational outcomes• (Bond et al, 1995, 1997, 2001; Grove, 2000; Meuser et 2004, Catty et al,

2007)• • No relationship between psychiatric symptomatology /• disability outcomes of vocational rehabilitation (Anthony, 1984,• 1995)• • Most studies show no relationship between employment• outcomes and diagnosis, severity of impairment and social• skills (Drake et al, 1994, 1996, 1999; Bond et al, 1995, 1997, 1999, 2001;• Meuser et al, 2004; Latimer et al, 2006; Burns et al, 2007)• • Employment history is a robust predictor of work outcomes,

but motivation and self-efficacy appear to be more important (Tsang et al, 2000; McDonald-Wilson et al, 2001)

IPS Principles• Eligibility is based on Individual choice – no exclusion

criteria

• Supported employment is integrated in clinical teams

• Competitive employment is primary goal

• Job search is rapid (within 4 weeks)

• Job finding & all assistance is individualised

• Employers are approached with needs of individual in mind

• Follow along supports are continuous

• Financial planning is provided

Measuring adherence

Effects of intervention depend on how it is delivered

Adherence to fidelity is key

• • Programmes that faithfully implement the key elements of an IPS service have better outcomes

• • For supported employment, this means higher

competitive employment rates (see Becker et al. 01, 06; McGrewet al. 05; Burns et al. 07)

Integrating clinical and vocationalServices (co-location)What are the benefits?

• Clinically sensitive

• Addresses concerns that:

– Employment serves as a stressor

– Will interfere with stability of client

• More effective engagement and retention

• Better communication

• Incorporation of vocational information into care plans

• Observation can convert sceptical or disinterested clinicians

• Better outcomes – clinicians carry responsibility of

coordination, consistency and coherence

IPS STEEERING GROUP

• Build consensus

• Plan and monitor IPS implementation

• Track and process outcomes

Facilitative Change Model

IPS Fidelity Review

High Fidelity IPS Implementation

Plan

IPS Employment Specialist Training

Embed Fidelity Reviews in internal

processes

Embedding what works

The East Midlands Academic Health Science Network (EM-AHSN) is further supporting the implementation of IPS within Nottinghamshire, Northamptonshire and

Derbyshire NHS Trusts

For more information and to access the advice and support available please contact:

[email protected]

The Leicester Diabetes

Risk ScoresShaun Barber

PhD student

University of Leicester




Title Arial

NICE algorithmPreventing type 2 diabetes: risk

identification and interventions for individuals at high risk

Methods of identification

One stage - Invasive Two stage - Non invasive

• Cheaper – saving £350 per case

• Engages people with their risk factors

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=mcfSDvLmCLuwlM&tbnid=Zpwc9KMRY9S7rM:&ved=0CAUQjRw&url=http://www.bathnes.gov.uk/services/jobs/your-application-form&ei=X2trU-6HKqXn7Aat2YGoCQ&bvm=bv.66330100,d.ZGU&psig=AFQjCNEwC-5svwdZJGK4vNq2oEBwIePh0Q&ust=1399635134243563


Risk Scores

• Self-assessment

• Applicable to an individual

• Opportunistic screening

• Automated

• Applicable to GP database

• Targeted mass invitation to screening



http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=AWl3lRDKS_EsxM&tbnid=jZ8vmlkKXASmCM:&ved=0CAUQjRw&url=http://www.redorbit.com/news/health/1112425729/100000-primary-care-providers-adopt-electronic-health-records/&ei=fWxzU-aHCoOiyATajYCoCA&bvm=bv.66699033,d.ZGU&psig=AFQjCNG2p0tVz41wQdKQca_0rEpaYTOGEw&ust=1400159733572741

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=AWl3lRDKS_EsxM&tbnid=jZ8vmlkKXASmCM:&ved=0CAUQjRw&url=http://www.redorbit.com/news/health/1112425729/100000-primary-care-providers-adopt-electronic-health-records/&ei=fWxzU-aHCoOiyATajYCoCA&bvm=bv.66699033,d.ZGU&psig=AFQjCNG2p0tVz41wQdKQca_0rEpaYTOGEw&ust=1400159733572741

Leicester Self Assessment Score

Text here

Title Arial

http://www.growingsupport.co.uk/partners/

http://www.growingsupport.co.uk/partners/

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAQQjRw&url=http://kellamstudios.co.uk/?p=55&ei=IExjU5bWCoXmOr2VgKgN&bvm=bv.65788261,d.ZWU&psig=AFQjCNGB-O7eA5pz0orFRSrRxGXezSPmFw&ust=1399102880222807

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAQQjRw&url=http://kellamstudios.co.uk/?p=55&ei=IExjU5bWCoXmOr2VgKgN&bvm=bv.65788261,d.ZWU&psig=AFQjCNGB-O7eA5pz0orFRSrRxGXezSPmFw&ust=1399102880222807

http://www.obesitysurgeonsgroup.co.uk/news/channel-4-embarrassing-fat-bodies

http://www.obesitysurgeonsgroup.co.uk/news/channel-4-embarrassing-fat-bodies

Automated score for GP databases

Risk Score = 0.0408359 x age

+ 0.1839942 (if male, no change in

female)

+ 0.7565977 (if BME)

+ 0.0820698 x BMI

+ 0.4770517 (if family history of

T2DM, no change otherwise)

+ 0.5498978 (if on

antihypertensive medication, no

change otherwise

• Developed software which integrates the risk score and electronic medical records

• Calculates score everyone 40-75 years excluding– Known Diabetes– Terminally ill– Coded Gestational diabetes

• Also analyses existing OGTT/glucose/HbA1c data– Identifies ‘missed’ diabetes– Gives precedence to fasting over random results (if unclear random assumed)– 2 glucose results on same day - assumes OGTT– Random blood glucose can only rule in diabetes if only result or latest data– HbA1c ≥6.5% T2DM, 6.0%-6.4% IGR, <6.0% normal

Primary Care Software

• Target screening

– Choosing a specific level of

risk (e.g. top 10%)

– Choosing a specific level of

sensitivity (e.g. 80%)

• First risk score to include

HbA1c in outcome


– http://www.leicesterdiabetescentre.org.uk/Leicest

er_Practice_Risk_Score-5905.html


http://www.leicesterdiabetescentre.org.uk/Leicester_Practice_Risk_Score-5905.html

Gray LJ et al. (2012) Diabetologia 55(4):959-66



• GPs and other primary healthcare

professionals should use a validated

computer-based risk-assessment tool

to identify people on their practice

register who may be at high risk of type

2 diabetes. The tool should use routinely

available data from patients' electronic

health records. If a computer-based risk-

assessment tool is not available, they

should provide a validated self-

assessment questionnaire, for example,

the Diabetes Risk Score assessment

tool. This is available to health

professionals on request from Diabetes

UK.

NICE - Identification of those at risk

Leicester Practice Risk Score

Leicester Self Assessment Score

NICE. Preventing type 2 diabetes: risk identification and interventions for individuals at high risk.

PHG38. 2012. http://guidance.nice.org.uk/PH38

http://guidance.nice.org.uk/PH38


[email protected]


@CLAHRC_EM

This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). The views expressed in this presentation are those

of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Naina Patel- Research AssociateDiabetes Research Centre, Leicester




Outline

• East Midlands Centre for BME health

• Vision and strategic objectives

• Achievements and future plans

• Leicester Self-Assessment Score (LSA)

• Translation Journey

Vision:

An organisation that is committed to actively inspiring and developing

dynamic, collaborative partnerships between patients, public, community and voluntary sectors, researchers,

health and social care organisations and others, to help address and reduce

ethnic health disparities in the East Midlands.

East Midlands Centre for Black and Minority Ethnic Health

• Develop and implement capacity building programmes for researchers and staff from healthcare organisations

• Actively influence a culture of practice in which BME PPI informs and supports research, service planning and commissioning

• Undertake community engagement strategies that foster the trust and buy-in of BME communities to take part in joint working in health and research

• To develop and provide a centralised repository of resources and information for organisations and individuals to share and disseminate

Strategic objectives

• Over 310 people have attended our events

• Conceptualising ethnicity in health and research workshop

• Collaboration with researchers

• 2 Current CLAHRC projects engaged with the Centre.

• Full facilitation and support to one project

• 7 prospective CLAHRC Phase 3 sought and named involvement of the Centre

• Website development –content and marketing strategy currently being developed

Key Achievements

Achievements and Future Plans

• A research project on raising awareness and prevention of type 2 diabetes in BME communities in Leicester to inform a social marketing campaign

• Systematic Review of insulin management and interventions

• Scoping of need for support during insulin treatment for patient and staff

• Develop plans for implementation of existing intervention where appropriate.

• A scoping review of existing services including those involved in the risk identification pathway.

• The journey:

• LSA developed by Dr Gray, University of Leicester, funded by Diabetes UK

• Currently accessed by over 750,000 people on DUK for risk assessment

• In 201O the LSA was translated into four South Asian languages: Gujarati, Urdu, Bengali and Punjabi

• In 2011, 2 focus groups with Punjabi and Gujarati participants were convened to assess the translation

• Key findings:

• lack of conceptual equivalence (intended comparable meaning) • pitched at too high a level in terms of language used:

LSA (1)

Dr R – question on ethnicity ..number 3 how did you find it ? easy or difficult?

AK – ‘Nasel ‘ the word used is a rude word….

RSF- it’s like what breed are you (laughs)…….nasel is the wrong word…..

DN- (..).when you first read the question what was the first thing that came into your head?

RSF – Alsatian (all laugh)

CS – surely, the person who translated this must have read it and realised what it means……

Qualitative findings from focus groups

• In 2012, grant from DUK to translate the LSA into Gujarati

• Key outcomes:

• Improved the LSA English and refined the risk score categories

• We have produced a conceptually equivalent and accurately translated Gujarati version of the LSA

LSA (2)

• Concept of risk and future risk and its translation was easily understood:

“ risk is you know jokem which I think any Gujarati people can understand. It could happen to them or they are already having that illness.”

• The LSA helps by personalising risk:

“I was shocked, I was shocked with the results..”(…….) Mainly for myself by working out the tables that makes that me feel that I should do something for myself so its that per..personal risk yeah.”

Findings from the qualitative stage of the LSA translation

• Future plans:

• Translate the LSA for Bengali and Punjabi in 2015

• To develop a mobile phone app of an audio version of the Gujarati LSA

LSA (3)

Joint event with RNIB on BME eye health and diabetes on 19/03/15

Thank you for [email protected]

N



PARADES Mental Capacity Act Booklet.

Richard MorrissEnhancing Mental Health Theme CLAHRC EM




• Mental Capacity Act 2005 allows people who temporarily or permanently lose their ability to understand or communicate decisions about their personal affairs including health in advance

Advanced Directive to Refuse Treatment (legally binding)Advanced Statement of Wishes and Feelings (treatment, personal and financial affairs)Lasting Power of Attorney (who will act for you)

• Not restricted to mental health

• House of Lords Select Committee 2013 evidence that the MCA has been poorly implemented in England

Background

• Serious mental illness with periods of mania – excitement, elation, over-activity, lack of sleep, disinhibited, reckless behaviour, excessive confidence; periods of depression

• 1.4% lifelong prevalence, onset 13-30 yrs

• Suicide rate 20x SMR general population

• Lose capacity in mania and depression for days to months, then regain capacity fully

Bipolar Disorder

Link with creativity• Mark Twain, Edgar Allen Poe, Walt Whitman, Sylvia Plath,

Tennessee Williams, Ernest Hemingway, Virginia Woolf, Ezra Pound, Charles Mingus, Gustav Mahler, Paul Gauguin, Georgia O'Keeffe, Jackson Pollack, Vincent van Gogh.

• Ozzy Osbourne, Jean-Claude Van Damme, Axl Rose, SinéadO'Conner, Peter Gabriel, Kurt Cobain, Stephen Fry, Russell Brand, Catherine Zeta Jones, John Cleese, Spike Milligan etc.

http://www.bing.com/images/search?q=Jackson+Pollock+Pictures&id=0019D68EF74D70D82E93E45E286DB7BEFA365085&FORM=IQFRBA

http://www.bing.com/images/search?q=Jackson+Pollock+Pictures&id=0019D68EF74D70D82E93E45E286DB7BEFA365085&FORM=IQFRBA

Years lived lost due to disability in the world in 2010Vos T et al Lancet 2012

Rank order

1. Low back pain 11. Osteoarthrosis

2. Major depressive disorder 12. Drug use disorders

3. Iron deficiency anaemia 13. Hearing loss

4. Neck pain 14. Asthma

5. COPD 15. Alcohol use disorders

6. Other musculoskeletal 16. Schizophrenia

7. Anxiety 17. Road injury

8. Migraine 18. Bipolar disorder

9. Diabetes mellitus 19. Dysthymia

10.Falls 20. Epilepsy

• Part of NIHR PARADES Programme Grant (leads for stream: Peter Bartlett, Richard Morriss, UoN)

• Aim to review uptake and use by service users with bipolar disorder and training of psychiatrists

• National survey of 549 service users, 650 psychiatrists, qualitative interviews

PARADES MCA study

• 94% service users thought making plans for welfare in this way was important or very important

• 36% service users heard of the MCA before the study

• 10% made ADRT, 11% ASWF, 5% LPOA. Psychiatrists confirmed very low take up

• Websites, documentation and accounts by service users and psychiatrists:

– Documentation when available not legally accurate

– No clear procedure to access MCA documents for service users or staff

– Psychiatrists and other NHS staff rarely discuss unless service user or carer raises it

Results

1. Chief investigator and theme manager

2. Summary reported as standing item to CLAHRC EM Executive and CLAHRC EM Board

Reporting

• Service users liked the written content – legally accurate

• Service users did not like images and layout so work with CLAHRC EM PPI to improve it

• CLAHRC EM PPI - MCA cards to let staff know of presence of MCA documents

• No plan to disseminate booklet beyond participants in survey

• Devised dissemination and implementation plan:– Dissemination events and publicity campaign – Bipolar UK, celebrity, political endorsement, social

media– Print run of paper copies and distribute to NHS organisations, bipolar UK, recovery college– Downloadable booklet, card and now survey from AHSN EM website.

CLAHRC and AHSN EM role

• 19, 800 downloads over 4 months

• 8,000 paper copies of booklet disseminated

• First course on MCA based on booklet and PARADES in Nottingham Recovery College

• Plans to disseminate via network of Recovery Colleges (2/3 Mental Health Trusts nationally) and Bipolar UK

• Adopted by SCIE

• Consider adaptation for other mental health and non-mental health conditions where capacity is temporarily lost

CLAHRC/AHSN EM dissemination

The IMPAKT Programme

IMproving Patient care and Awareness of Kidney disease progression Together

Research, Implementation, QI, and Commissioning

• Rare to common

• Complex to routine

• Secondary to primary care

A Paradigm Shift in Thinking About Kidney Care

Big changes in kidney medicine since 2006

- new nomenclature - CKD

- a new way of measuring kidney function

- a new way of grading severity

11th May 2006

• A primary-secondary care partnership to prevent adverse outcomes in CKD

• Nigel Brunskill Principal Investigator

CKD

“Intensive CKD disease management in primary care, supported by secondary care, will improve outcomes”

Hypothesis

• take a number of general practices

• identify all CKD patients

• divide practices into 2 groups

• 1 group continues to provide ‘normal’ CKD care

• 1 group provides nurse led ‘intensified’ CKD care

• team of CKD nurses supported by secondary care

• compare CKD outcomes after an appropriate time period

How to test the hypothesis:

A robust data extraction tool applicableto all GP computer systems

What do we need to do this?

www.impakt.org.uk

What the tool does:

Register– Accuracy of existing coding of CKD

– Identifies uncoded patients

Risk– Identifies high risk of progression and CVD

– Medicines management

Audit– Against NICE standards

– Benchmarking

Manage– Advice on BP, proteinuria, ACE/ARB

– Referral

– Medicines management – NSAIDs, metformin etcwww.impakt.org.uk

MANAGE 2: Proteinuria testing and BP control Practice Name

Managing blood pressure in my CKD patients 20/11/2012 P12345

Proteinuria testing Total % Blood pressure management

BP

recorded

in last

year

BP

treated to

target

% treatedTotal left

to treat

% left to

treat

CKD patients tested for proteinuria 326 83 Of those with proteinuria status recorded:

CKD patients not tested for proteinuria 65 17 BP 140/90 (CKD without proteinuria) 259 180 69 79 31

Of those tested: BP 130/80 (CKD with proteinuria) 42 11 26 31 74

CKD patients with proteinuria 43 0 Patients treated to appropriate BP target 301 191 63 110 37

CKD patients tested but not coded 17

%

35

\

NICE sets two different blood pressure recommendations for patients with CKD, based on the presence of proteinuria. Therefore it is important to test all of your CKD

patients for proteinuria (QOF suggests that this is done at least every 15 months) so that you can define which of the two targets you should use for your patients. NICE

recommendations are that patients with proteinuria are controlled to 130/80, and those without proteinuria to 140/90.

CKD patients without proteinuria 266 3Please select or input a target % of patients treated to appropriate BP target from the drop down

menu below. Your selected % will be converted to a number of patients to find on the graph below.

Controlling blood pressure - what do I need to know?

You have chosen to find 75% of your total patients treated

326

65

0

10

20

30

40

50

60

70

80

90

100

ACR testing

% Tested % Not Tested

43

266

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Number of patients tested for proteinuria

With proteinuria

Without proteinuria

11

180

191

13

213

226

42

259

301

0% 20% 40% 60% 80% 100%

BP 130/80 (CKD with

proteinuria)

BP 140/90 (CKD without

proteinuria)

Patients treated toappropriate BP target

% of patients treated

Blood pressure management

75% Target

% missing

75

MANAGE 1: Stratifying risk of progressive CKD Practice Name

Controlling risk factors for my CKD patients

Albuminura stages, description and range (mg/mmol) Risk factor stratification

A1 A2 A3 Score

10 or more 0

9 0

<10 10-29 30-299 300-2000 >2000 8 0

7 1

6 4

5 9

4 29

CKD3a Mild-moderate 204 15 13 1 3 68

CKD3b Moderate-severe 64 4 6 2 2 120

CKD4 Severe 12 1 2 1 160

CKD5 Kidney failure 1 1 391

Some medication

Proteinuria heat map - what does it mean?

IMPAKT reads how many of your CKD patients have been

tested for proteinuria and plots them on the above heat

map. The more severe grouping represents a higher risk of

the patient suffering from progressive CKD. Use IMPAKT to

find the patients at highest risk so that you can control

their risk factors.

Low risk

Mild risk

Moderate risk

Severe risk

Very severe risk

Total patients

Risk groups

Use this page to stratify risk factors for your CKD patients and make adjustments

to how they are managed to reduce the risk of progressive CKD. This report

contains details on what risk each of your patients' readings for proteinuria

represents against their latest eGFR evidence, a breakdown of the number of risk

factors per CKD patient on your register, CKD patients that are prescribed

nephrotoxic drugs, and CKD patients that may meet the criteria for referral to

secondary care specialists.You can find each category of patient within IMPAKT on

your practice system.

How do I use the information on this page?

IMPAKT analyses 12 unweighted risk factors for

progressive CKD and calculates how many risk factor

categories each of your CKD patients fall into. Use

IMPAKT to investigate those patients appearing most

frequently to manage their risk factors.

No. of patients with referral advice markersIMPAKT has identified this as the number of your CKD patients that may meet NICE CKD guidelines (2008) criteria

for referral to specialist renal services.20

0

233

76

15

2

326

Total patients

Stratifying risk factors

GFR stages,

description and

range

(ml/min/1.73m2)

CKD1

CKD2

Optimal

Low-normal

30-44

15-29

<15

Total patients

>105

90-104

75-89

60-74

45-59

20/11/2012 P12345

Composite ranking for relative risks by GFR and

albuminuria (KDIGO 2009)Optimal to high-

normal

High Very high to

nephrotic

No. of

patients

Ranked by combined

risk score

150

0 50 100 150 200

Patients with advice markers for prescribed drugs

Number of patientscoded with CKD

IMPAKT PSP CKD Database

• 48 practices in Northants• >30,000 patients with CKD• 6 years data• Detailed data:

- demographics- co-morbidity- prescribed medications- lab results

• Millions of data points

• Rich resource for further study

IMPAKT Implementation:

- EM AHSN- Greater Manchester AHSN- West Yorks- North Wales- West Midlands

IMPAKT Pilot Implementation by West Leics CCG2014/15

• supported by Baxter Healthcare• 77% of practices reported improved CKD prevalence• 77% of practices reported increased % CKD patients at BP target• 55% of practices reported improved prescriptions of ACEi/ARBs

Now a commissioned service for 2015/16

IMPAKTNIHR new media competition winner 2013

Ongoing IMPAKT developmentEValuating CKD and Other Long term condition data

in primary care to predict and preVEnt

Acute Kidney Injury and unscheduled care

IMPAKT-EVOLVE-AKI

IMPAKT-EVOLVE-AKI

• Combines practice data and hospital lab data• First informatics solution to study community AKI• Data on associated causal AKI risk factors• Provides ability to measure efficacy of AKI interventions

IMPAKT provides comprehensive suite of tools for management of both acute and chronic kidney

disease

BITEsBrokering Innovation Through Evidence

Kamlesh Khunti, Director, CLAHRC East Midlands




BITEs & Evidence summaries

• Previous NIHR CLAHRCs for NDL and LNR (2008-14) produced around

50 BITEs.

CLAHRC East Midlands BITEs

• CLAHRC East Midlands has produced 18 BITEs since January

2015.

• BITEs from all previous and current NIHR CLAHRCs can be found

on the National Institute for Health and Care Excellence (NICE)

website.

Mental Health BITEs

Chronic Disease BITEs

Primary Care BITEs

Older People and Stroke BITEs

Implementation and PPI BITEs

• CLAHRC EM is committed to

producing at least 30 BITEs and

we expect to produce a BITE for

every significant publication,

finding or activity

• We are committed to publicising

our achievements and the

impacts our work can have on

health to all relevant people and

bodies.

BITEs Future


[email protected]


@CLAHRC_EM

@kamleshkhunti



Join the conversation

If you hear something you like, or want to

challenge, or simply want to share an

observation, join the Twitter conversation using

@CLAHRC_EM and #clahrc in your tweet.

#clahrc@CLAHRC_EM

NIHR CLAHRC East Midlands related Twitter accounts

@EMRAN_ageingEast Midlands Research into Ageing Network

@EMCBMEHEast Midlands Centre for Black and Minority Ethnic Health

Connecting to venue WiFi

• Load web browser

• Click “conference” on homepage

• Enter Username diabetes1, Password diabetes1

Username:

diabetes1

Password:

diabetes1

NIHR CLAHRC East Midlands Showcase

Chair – Professor John Gladman, Theme Lead, Caring for

Older People and Stroke Survivors




Charlotte Hall Shireen PatelEnhancing Mental Health Theme

Co-production in the Enhancing Mental

Health Theme

What Works?

AQUA -Trial Helping Urgent Care Users Cope

with Distress about Physical

Complaints Study




Projects

Urgent Care Users StudyAQUA-Trial

RCT: National

3 years, matched industry

CAMHS & Community Paediatrics

178-234 participants

6-17 years, referred for ADHD assessment

RCT: East Midlands

4 years, matched NHS

Primary & Secondary Care (ED)

144 participants

18 years and over, ≥ 2 unscheduled/urgent care attendances in last 12 months

Progress to date

AQUA = Ethical approval, CRN adopted, 8 NHS Trust (9 sites) = 141 participantsUrgent Care = Ethical approval, CRN adopted, 1 ED & 4 GP Practices = 16 participants

Network of Practice

Brings together research partners, patients, service commissioners and service providers to maintain strong links with those who can benefit from the study

Who?

AQUA-Trial

- Site PIs - Supporting clinicians / admin

staff- QbTech- Academic team- Knowledge Brokers- PPI

We are widening this to include service providers/managers & commissioners

Urgent Care Users Study

- Local collaborators - Supporting clinicians/admin

staff- CBT therapists- Academic team- Knowledge Brokers- CCGs- PPI

Attended by anyone who is interested in the study/how Networks of Practice operate

How?


- Weekly email contact with local collaborators

- Telephone or face to face contact

- Network of Practice meetings (every 3/4 months)

AQUA-Trial

- Weekly contact with Site PIs

- Monthly newsletters- Monthly dial-in

sessions- AQUA-Forums (approx

3/4mths)

PPI


- Fred Higton & David Waldram

AQUA-Trial

- ADHD Solutions, Nikki Brown, David Waldram



@CLAHRC_EM



The Prevention Theme

Kamlesh Khunti, Theme Lead

Carol Akroyd, Theme Manager


Nottinghamshire Healthcare NHS

Foundation Trust

and the Universities of Nottingham and

Leicester

EM CLAHRC ThemesThe Research

Implementation of a diabetes prevention pathway in a multi-ethnic population

Let’s Prevent Diabetes is evidence-based and soon to be made available nationally to commissioners.

This project aims to develop a model of implementation to meet the needs of local communities

Nicotine Replacement Therapy

• To develop and evaluate evidence-based, smoking cessation behaviour change techniques (BCTs) which are specifically tailored for use in pregnancy.

• As appropriate, to embed newly-developed BCTs, into routine NHS care using the National Centre for Smoking Cessation Training’s online learning environment and face-to-face training courses.

CVD PREVENTION

A randomised controlled trial to investigate the effect of structured education on preventing heart disease and other vascular conditions in people at high risk

Move to Teach: Move to Learn

• Young children today are increasingly driven to school and learning means sitting at a desk.

• Children engage in considerable sitting time in the school classroom and thus the potential for reducing this holds promise.

• However, few interventions have focused on reducing or breaking up sitting in the primary school classroom.


The project will be delivered over 4 phases

1. Development of an intervention ‘toolbox’

2. Implementation of ‘toolbox’ & short term evaluation

3. Evaluation of sustained ‘toolbox’ use

4. Dissemination

The ‘toolbox’ will be delivered in a total of 6 schools for (up to) one academic year, to Year 5 pupils (9-10 years)


• Ash Routen, Research Associate, Move to teach: Move to learn, Loughborough University

• A collaborative project to develop and implement an intervention ‘toolbox’ to reduce sitting in the primary school classroom

Caring for Older People and Stroke

Survivors

Yvonne R Simpson

COPSS Theme Manager




The COPSS Theme Envelope

EMRAN

PhD Students

KnowledgeBrokers

Links to Research Networks

Stakeholder /Partner Engagement

Public Engagement


Applied Health and Implementation Research – links to IEI Theme

Links to Industry

SOPRANO Phase 1 Study

REVIHR Phase 1 Study

Ambulance Hypo Phase 2 Study

Phase 3 Projects

SOPRANO (Phase 1 Study)

Study Lead – Professor John Gladman

Supporting Older People’s Resilience through Assessing Needs and Outcomes

REVIHR (Phase 1 Study)

Study Lead – Professor Marion Walker MBE

Evidence based in-hospital stroke rehabilitation

Ambulance Hypo Study (Phase 2 Study)

Study Lead – Professor Kamlesh Khunti

Enhanced care pathway for people receiving an ambulance call out for hypoglycaemia

COPSS Theme Studies

• Monthly Theme Meetings – well attended

• Draw on wider CLAHRC EM expertise

• Building strong links with the IEI Theme for Study

evaluation

• Active engagement with our PhD students

• Support existing and potential projects

• Proactively engage with public and patient involvement,

knowledge brokers and networks

The COPSS way of working

• Challenges within studies have been met and overcome

• Draw on resources within CLAHRC EM

• Committed Researchers

• Focussed COPSS team with positive ethos to get things done

• Structured ways of working – supporting one another

• EMRAN

Being positive – credit to the team

Filling the gap in the East Midlands

EMRAN

the story so far ….

Title Arial

Implementing Evidence &

ImprovementsProfessor Justin Waring

IEI Theme Lead, NIHR CLAHRC East Midlands




NIHR CLAHRC-EM undertakes world-class applied health research that aims to close the gap between research and practice!

• Applied research – research that tests ‘proven interventions’ in the context of local care services and needs

• Closing the gap – research that is ‘co-produced’ by research and practice communities so that it fits with the context of local care services and needs

• Co-production – where research teams and practitioners work together to design and ‘implement’ applied research

• Implementation research – research that aims to understand how best to co-produce and implement research

The CLAHRC Approach

• What is our purpose?

– To understand about how world-class applied health research can be co-produced

by researchers, commissioners, care providers and public stakeholders

– To appraise the specific co-production approaches developed and used by

CLAHRC-EM, especially PPI, networks and knowledge brokers

– To advance knowledge about co-production and implementation of service

improvements

• What is our Philosophy

– To co-produce research on co-produced research – working in partnership with

study teams and communities

– To provide formative learning and feedback on the learning process

The IEI Theme

EMH COPSS

IEI

MCDPCD

Partners

/ AHSN

Investigate different implementation activities

from across projects to develop formative &

comparative learning

Provide

formative

learning to

projects &

partners

Managing and

conducting applied

research

Putting the Implementing

Evidence & Improvement

Theme in Context

• Public Involvement

• Knowledge Brokers

• Networks of Practice

• Dissemination

• Capacity Building

The CLAHRC Approach

1. Thematic Review of the CLAHRC-EM portfolio

2. A Stronger Voice: the role of PPI in the commissioning and

provision of evidence-based interventions

3. Clinical Interventions as Networks: the role of social interaction

within networks of practice

4. Practices of Knowledge Brokering in the co-production and

translation process

Our Projects

• Why was this research is needed?

– CLAHRC-EM is organised around 4 clinic themes, but the individual projects

reflect a diverse range of interventions, co-production techniques, research

methods and patient groups

– A new way of analysing the CLAHRC was needed to better understand how it

worked to co-produce world-class applied research

• What did the research involve?

– Desk-based review of all CLAHRC projects to identify different approaches to

co-production

• Who led this research?

– Lewis Hyland & Jenelle Clarke, University of Nottingham

Thematic Review of CLAHRC

Why is this research needed?

Project Theme PI Aims Implementation

Strategy

Implementation

partners

Implementation process

measures

REVIHR Networking,

Education,

Assessment

PI- Marion

Walker

1) Use current stroke audit

data (SSNAP) to identify

high/low scores in achieving

highest standards of stroke

care

2) Develop theory of change

model to inform intervention

3) behavioural and

qualitative mapping of

delivery, identify key issues

as to whether delivery is

evidence based

4) Identify

barriers/facilitators of

delivering evidence based

care

Early PPI,

ongoing

integration of

change

programme.

Pilot change

programme run in

collaboration with

EMAHSN and

Strategic Clinical

Network. PPI

involvement

through the

Nottingham Stroke

Research

Consumer Group.

This is accounted for through

the use of behavioural

mapping in Phase 2 of the

process

HYPOGL Education,

Evaluation,

Brokering

PI - Kamlesh

Khunti

Adjust prescribed diabetes

medication through nurse

referral after ambulance call

out.

Implement/evaluate an

hypoglycaemia pathway for

patients receiving

ambulance call out.

PPI involvement

has been

extensive at the

Leicester site

with further

discussion

planned in

setting up the

pathway at tow

further sites.

Integrated Care

Diabetes Service

(ICDS) Leicester.

DSNs (Diabetes

Specialist Nurses)

in the delivery of

the care pathway.

EMAS (East

Midlands

Ambulance

Service) are

closely involved.

A number of DSN's were

involved in the design and

delivery process. Meetings

will be organised with primary

care practitioners and

individuals in the field of

hypoglycaemia. Knowledge

brokers are connected to

Leicester City CCG and the

further two sites. Routes of

information dissemination

include Pre-Hospital

Emergency Services Cuttent

Awareness Update,

Association of Ambulance

Chief Executives, and to the

National Ambulance Service

Medical Directors group.

• Why this research is needed?

– PPI can help services to efficiently and effectively meet the needs of stakeholders,

but, it can be time consuming and seen as ‘tokenistic’!

– Evidence is needed on how best PPI can ensure patient and public voices influence

decision-making in the commissioning and provision of evidence-based interventions

• What does the research involve?

– Confidential interviews with key decision-making agencies to understand their views

about and approaches for PPI, including the role of PPI in applied research

– Observations and documentary analysis of key decision-making processes to

understand the role and influence of PPI

• Who is leading the research?

– Pam Carter & Graham Martin, University of Leicester

A Stronger Voice!

• Why this research is needed?– CLAHRC-EM projects bring together different people in the form of a new

‘community’ or ‘network’ to co-produce and implement research

– Evidence is needed on how these ‘networks’ can create a shared sense of purpose, vision and energy to co-produce research

• What does the research involve?– Observations of 6 different CLAHRC project networks (e.g. meetings, training

etc) to understand how a shared purpose can emerge

– Interviews with study teams and network members to understand the extent of shared purpose

• Who is leading the research?– Jenelle Clarke, Stephen Timmons & Justin Waring, University of Nottingham

Clinical Interventions as Networks

• Why this research is needed?– EM-CLAHRC projects use a variety of ‘knowledge brokers’ to ensure research

reflects the local experiences and needs of service providers

– Evidence is needed on the activities or ‘practices’ that facilitate the translation of knowledge between research and practice groups

• What does the research involve?– Observations of 6 different CLAHRC project teams to understand the roles

played by different knowledge brokers

– Interviews with study teams and brokers to understand how knowledge is translated and share

• Who is leading the research?– Lewis Hyland, Justin Waring & Stephen Timmons, University of Nottingham

The Practices of Knowledge Brokering

• Identifying key strategic needs for Phase 3 studies:

– The implementation and adoption of national guidelines

– Working collaboratively with business and industry

• Evaluating and appraising our CLAHRC approach

– How do our different co-production and translation approaches compare?

– What types of evidence and co-production to commissioners value?

– To what extent has change been sustained in practice?

Future Plans


[email protected]


@CLAHRC_EM



Open Space: NIHR CLAHRC East Midlands

Sharing Best Practice




Thank you for attending


@CLAHRC_EM

nihr clahrc east midlands annual meeting 2015 presentations - day 1

Healthcare

east midlands health

research networks

research evidencedevelop

high quality health

nottingham1 east midlands

health providers

health inequalities

health of children